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Heterotaxy syndrome, also called atrial isomerism, is a rare congenital condition in which the internal organs are abnormally arranged across the left-right axis of the body. It is classified into polysplenia syndrome or left atrial isomerism and asplenia syndrome or right atrial isomerism. It is associated with high morbidity and mortality due to the severity of cardiac anomalies. It is important to be aware of the syndrome findings as they can be incidentally found on imaging in adults. Here, we report a case of a 33-year-old female who presented with worsening shortness of breath, found to have a pulmonary embolism, and heterotaxy was incidentally identified on her imaging. A concise review follows.
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Pasteurella multocida is a small Gram-negative organism that usually causes a localized infection after exposure to cat or dog scratches, bites, or licking wounds. Invasive infections, such as bacteremia and endocarditis, are very rare yet serious conditions that are associated with high morbidity and mortality, particularly in patients with major comorbidities. Here, we report a case of a 47-year-old male who presented to the hospital with altered mental status two weeks after a fall and was found to have a subarachnoid hemorrhage. Further workup revealed Pasteurella multocida bacteremia and infective endocarditis. The patient had a complex hospital course with septic shock and acute congestive heart failure with poor clinical outcomes. A comprehensive review of the literature of all reported cases of definite Pasteurella endocarditis follows.
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BACKGROUND: Patients with true paroxysmal supraventricular tachycardia (PSVT) are frequently misdiagnosed with panic or anxiety disorders due to similar symptoms of palpitations, light-headedness, dyspnea, or chest discomfort. Unrecognized PSVT can lead to unnecessary management with anxiety medications. Treatment of PSVT with catheter ablation may lead to a reduction in anxiety medications. Methods: A total of 175 patients underwent successful PSVT ablation between January 1, 2010 and December 31, 2020. We examined symptoms at presentation, psychiatric medications prior to PSVT ablation, comorbidities, and psychiatric medications at three months post-ablation. Results: Fifteen percent of patients who underwent successful PSVT ablation were being treated with psychiatric medications and included in the final study population. The most common symptoms were palpitations (80.77%), followed by dizziness (42.31%), and shortness of breath (34.62%). The average number of medications prior to ablation was 1.42 and decreased to 1.08 at three months post-ablation (p = 0.04). The average number of selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other anxiolytics also decreased but was not statistically significant. CONCLUSION: In patients with anxiety and PSVT, catheter ablation reduced the average number of psychiatric medications.
RESUMO
Rituximab has been widely used alone or in combination therapy to treat B-cell non-Hodgkin lymphoma, chronic lymphocytic leukemia, and various autoimmune diseases. Although it is a relatively safe drug, rare rituximab-induced interstitial lung disease (RTX-ILD) has been reported and can be potentially fatal. Here, we report a patient with stage 4 mantle cell lymphoma on rituximab who presented with non-ST segment elevation myocardial infarction in the setting of severe respiratory distress. He underwent left heart catheterization that revealed no new obstructive lesions and patent grafts. Extensive Infectious and autoimmune workup was negative except for Stenotrophomonas maltophilia pneumonia. The patient was diagnosed later with probable RTX-ILD after exclusion of other etiologies, and he did not show any signs of clinical improvement despite antibiotics and steroid therapy. The patient was then discharged to a long-term acute care hospital, where he eventually passed away.